The Affordable Health Care for America Act was approved by the U.S. House Saturday night with overwhelming support from progressive Democrats who serve in the chamber and from a president who was nominated and elected with the enthusiastic support of progressive voters.
But that does not mean that informed and engaged progressives are entirely enthusiastic about the measure.
In fact, some are openly and explicitly opposed to it -- among them former Congressional Progressive Caucus chair Dennis Kucinich, D-Ohio, and CPC member Eric Massa, D-New York, both of whom broke with the majority of their fellow Democrats to vote "no" when the House approved the measure by a narrow 220-215 vote Saturday.
How can this be?
Isn't this a fight between Democrats and Republicans? Between reforming liberals and tea-party conservatives?
How can there possibly be any subtlety or nuance to this debate?
Well, of course, the debate over this 1,900-page behemoth of a bill is more complicated than the easy spin of political insiders -- and media cheering sections -- would have Americans believe.
Key interest groups, such as the National Organization for Women, and key congressmen who have been long-term supporters of reform, such as single-payer backers Massa and Kucinich, argue that the bill is not the cure for what ails the U.S. health care system.
Indeed, they suggest, the bill as it is currently constructed could make a bad situation worse.
Many sincere progressives in the House, and outside of it, chose to back the bill as the best that could be gotten. Others supported it on the theory that flaws could be fixed in the Senate and in the reconciliation of the House and Senate bills.
But those repairs will only be made if activists are conscious of what ails this bill.
For that reason, even supporters of the House legislation would be wise to consider the criticisms of it by groups that advocate for the rights of women, patient advocates, unions and some of the most progressive members of the House.
Here are six smart progressive complaints about the House bill:
1. FROM CONGRESSMAN ERIC MASSA: "This Bill Will Enshrine in Law the Monopolistic Powers of the Private Health Insurance Industry"
At the highest level, this bill will enshrine in law the monopolistic powers of the private health insurance industry, period. There's really no other way to look at it. I believe the private health insurance industry is part of the problem. This bill also, I believe, fails to address the fundamental question before the American people, and that is how do we control the costs of health care. It does not address interstate portability, as Medicare does. It does not address real medical malpractice insurance reform. It does not address the incredible waste and fraud that are currently in the system.
2. FROM THE CALIFORNIA NURSES ASSOCIATION: This Bill Fails to Control Costs
While the current bills will provide limited assistance for some, the inconvenient truth is they fall far short in effective controls on skyrocketing insurance, pharmaceutical and hospital costs, do little to stop insurance companies from denying needed medical care recommended by doctors, and provide little relief for Americans with employer-sponsored insurance worried about health security for themselves and their families.
3. FROM THE NATIONAL ORGANIZATION FOR WOMEN: "This Bill Obliterates Women's Fundamental Right to Choose"
The House of Representatives has dealt the worst blow to women's fundamental right to self-determination in order to buy a few votes for reform of the profit-driven health insurance industry. We must protect the rights we fought for in Roe v. Wade. We cannot and will not support a health care bill that strips millions of women of their existing access to abortion. Birth control and abortion are integral aspects of women's health care needs. Health care reform should not be a vehicle to obliterate a woman's fundamental right to choose.
The Stupak Amendment (to the House bill, which was approved and attached on Saturday) goes far beyond the abusive Hyde Amendment, which has denied federal funding of abortion since 1976. The Stupak Amendment, if incorporated into the final version of health insurance reform legislation, will:
• Prevent women receiving tax subsidies from using their own money to purchase private insurance that covers abortion;
- Prevent women participating in the public health insurance exchange, administered by private insurance companies, from using 100 percent of their own money to purchase private insurance that covers abortion;
• Prevent low-income women from accessing abortion entirely, in many cases.
NOW calls on the Senate to pass a health care bill that respects women's constitutionally protected right to abortion and calls on President Obama to refuse to sign any health care bill that restricts women's access to affordable, quality reproductive health care.
4. FROM PLANNED PARENTHOOD'S CECILE RICHARDS: This Bill Embraces Religious-Right Extremes
It is extremely unfortunate that the United States Conference of Catholic Bishops and anti-choice opponents were able to hijack the health care reform bill in their dedicated attempt to ban all legal abortion In the United States. Most telling is the fact that the vast majority of members of the House who supported the Stupak/Pitts amendment in today's vote do not support HR 3962, revealing their true motive, which is to kill the health care reform bill.
These single-issue advocates simply used health care reform to advance their extreme, ideological agenda at the expense of tens of millions of women.
5. FROM CONGRESSMAN DENNIS KUCINICH,: This Bill Worries About the Health of Wall Street, Not America
We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care. We cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem. When health insurance companies deny care or raise premiums, co-pays and deductibles they are simply trying to make a profit. That is our system. Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000 percent. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.
But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies - a bailout under a blue cross.
By incurring only a new requirement to cover pre-existing conditions, a weakened public option, and a few other important but limited concessions, the health insurance companies are getting quite a deal. The Center for American Progress' blog, Think Progress, states, 'since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise.' Similarly, healthcare stocks rallied when Senator Max Baucus introduced a bill without a public option. Bloomberg reports that Curtis Lane, a prominent health industry investor, predicted a few weeks ago that 'money will start flowing in again' to health insurance stocks after passage of the legislation. Investors.com last month reported that pharmacy benefit managers share prices are hitting all-time highs, with the only industry worry that the Administration would reverse its decision not to negotiate Medicare Part D drug prices, leaving in place a Bush Administration policy.
During the debate, when the interests of insurance companies would have been effectively challenged, that challenge was turned back. The 'robust public option' which would have offered a modicum of competition to a monopolistic industry was whittled down from an initial potential enrollment of 129 million Americans to 6 million. An amendment which would have protected the rights of states to pursue single-payer health care was stripped from the bill at the request of the Administration. Looking ahead, we cringe at the prospect of even greater favors for insurance companies.
Recent rises in unemployment indicate a widening separation between the finance economy and the real economy. The finance economy considers the health of Wall Street, rising corporate profits, and banks' hoarding of cash, much of it from taxpayers, as sign of an economic recovery. However in the real economy - in which most Americans live - the recession is not over. Rising unemployment, business failures, bankruptcies and foreclosures are still hammering Main Street.
This health care bill continues the redistribution of wealth to Wall Street at the expense of America's manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.
Notwithstanding the fate of H.R. 3962, America will someday come to recognize the broad social and economic benefits of a not-for-profit, single-payer health care system, which is good for the American people and good for America's businesses, with of course the notable exceptions being insurance and pharmaceuticals.
6. FROM "SICKO'S" DONNA SMITH: The Bill Does Not Cure What Ails Us
Passing a healthcare reform bill that does not provide me with better access to care or protection from bankruptcy and financial ruin is not what I asked you all to do. Stripping away all reference to a progressively financed, single standard of high quality healthcare for all - also known as single-payer -- is done only to more deeply ensconce the deep pocketed interests in healthcare: the private, for-profit insurance giants, the big pharmaceuticals, the medical equipment companies, the hospital corporations and all the other making huge profits as thousands die needless deaths. Healthcare is a basic human right. Granting that right is not something to be calculated differently in swing Congressional districts, off-year election strategy or second-Presidential term planning. It is your (members of Congress') duty to me, to my fellow citizens and to your nation.
And (members of Congress) are marching away from reality when you think all the hard-working people who counted on you to make this a better healthcare system will not notice when you deliver insurance purchase mandates and a corporate bail-out that will dwarf the Wall Street trillions you've already justified.
Watch Smith's video: "American Sickos: Will the Current Bills Help? No"
Follow Smith's organizing for real reform at the website of Progressive Democrats of America. She is the national co-chair of PDA's Healthcare NOT Warfare campaign.
© 2009 The Nation
John Nichols is Washington correspondent for The Nation and associate editor of The Capital Times in Madison, Wisconsin. A co-founder of the media reform organization Free Press, Nichols is is co-author with Robert W. McChesney of Tragedy & Farce: How the American Media Sell Wars, Spin Elections, and Destroy Democracy - from The New Press. Nichols' latest book is The Genius of Impeachment: The Founders' Cure for Royalism.
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